This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, August 03, 2013

Weekly Overseas Health IT Links - 4th August, 2013.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Given the steady stream of new devices entering the healthcare market, it might be easy to start thinking improvements in healthcare can come from technological advances alone. But it's more complicated than that.

More often, improving healthcare boils down to identifying the gaps in the ways care is delivered, and figuring out how to fill them.

Kevin Quinn, senior vice president of sales and account management for New York-based AMC Health, says that while his company was focused on using technology to improve remote care, it “was created with the idea that using health IT can’t be just about the technology."

Instead, he says, "technology is a tool that should be used to enhance the experience of both patients and clinicians" – one best put to work “helping customers recognize where their gaps are" and helping make those gaps disappear.

Cost overruns and missed deadlines for several federal agency health technology projects are costing the government "billions of dollars," according to a Government Accountability Office report focusing on the inefficiency of agency IT initiatives published Thursday.

The report, which refers to the projects as "challenges" or "failures," also reveals that a public website developed by the Office of Management and Budget (OMB) to track technology spending--the IT Dashboard--is plagued with inaccurate cost and schedule information.

Technology mishaps are the cause of almost 25 percent of operating room errors, according to a study published this week in BMJ Quality & Safety.

The configuration or settings of a device or machine caused problems in about 43 percent of cases, according to researchers, who retroactively reviewed 28 published studies on OR errors. For roughly one-third of cases, a device or machine wasn't working properly.

Failures of equipment/technology accounted for a median 23.5 percent of total error.

The Royal College of Nursing has called for more nursing input into IT and more IT training for nurses after a survey uncovered a lack of confidence in clinical systems.

The survey of 1,000 RCN members found the majority of nurses had no influence on the way technology was used in their workplace.

Just under half (46%) said they had not been consulted at all about the introduction of IT systems and 54% said they had not been able to influence their use, even though 85% used a variety of systems on a daily basis.

In addition, the survey found that many nurses are still struggling to share PCs, instead of using more modern technology at the bedside.

A report on the survey says: “35% stated they had insufficient access to ICT equipment, or that the type of ICT tools they used were inadequate for their roles.”

The recent deadly Asiana Airlines crash in San Francisco called into question whether pilots rely too much on technology. The broader issues of technology's hidden dangers are important for healthcare as well, according to someone who knows about both--Nathaniel Sims, M.D., a pilot and physician advisor for biomedical engineering at Massachusetts General Hospital in Boston.

He outlines his perspective on how the two fields relate in a post for the Association for the Advancement of Medical Instrumentation (AAMI) Blog.

"The risk that arises in any industry, including aviation and healthcare, when automation is introduced, is the potential for basic skills to grow rusty," Sims writes. Before technology automation, professionals were more adept at responding to unusual circumstances and mishaps. Now, with automation removing some from exercising basic skills on a more regular basis, reaction is delayed.

When Rick Ramirez started experiencing sharp pains in his back and legs last year, a doctor was unable to find the cause. But as the pain continued, the 27-year-old Utah brokerage-firm staffer turned to an online symptom-checker named Isabel designed to help patients figure out what's ailing them.

With an abundance of websites and apps offering similar services, consumers are increasingly acting as their own diagnosticians when they experience a new health problem. That can be alarming for doctors, especially if patients show up armed with a scary list of unlikely maladies from the Internet, demanding expensive and unnecessary tests. It can also be dangerous for patients if they fail to seek expert medical advice for a problem after mistakenly concluding they don't need a doctor.

The mergers and acquisitions market has been very robust in healthcare generally and in health IT in particular, said Jonathan Krieger, managing director for healthcare investment banking for Berkery Noyes, an investment banking advisory firm, in an interview with InformationWeek Healthcare.

Krieger attributed this M&A activity primarily to healthcare reform, which is forcing the $3 trillion industry to change its business model. "Companies that have figured out how to succeed in this new paradigm, and those companies that have supplied health IT solutions to address the changes that are occurring, are doing well. And investors perceive this as a huge opportunity. Any time you have change in industries, it presents opportunities for companies that come out with software solutions to address those changes."

July 25, 2013 -- During the recent Society for Imaging Informatics in Medicine (SIIM) annual conference, there was an overriding message to healthcare imaging and IT professionals that they should learn more about HL7, especially as image-enabling the electronic medical record (EMR) is becoming a very hot item.

HL7 is not rocket science, and like any other standard, being able to "talk" HL7 is just a matter of knowing the most common terms and where to look for what information.

Most healthcare imaging and IT professionals don't really have to be experts; there are enough of those within an institution. However, the problem is typically how to communicate with vendors and the HL7 experts and know enough to visualize any issues and bring them to the surface. By the way, we are concentrating on version 2.x, as version 3 is a completely different story and will be covered elsewhere.

The Regenstrief Institute and the International Health Terminology Standards Development Organisation announced Wednesday they have signed a long-term agreement to begin cooperative work linking their global healthcare terminologies: Logical Observation Identifiers Names and Codes, or LOINC, and SNOMED Clinical Terms.

This timely and significant agreement will help improve safety, functionality and interoperability for the rapidly growing number of clinicians who manage and exchange health data with electronic medical records, leaders from both groups said in a news release.

This agreement builds on and complements the strengths of both organizations and terminologies. The cooperative work will connect the clinical semantics of SNOMED CT to LOINC codes, which provide extensive coverage of laboratory tests and some types of clinical measurements. By aligning how the two terminologies represent the attributes of laboratory tests and some types of clinical measurements, this collaboration will provide users a common framework within which to use LOINC and SNOMED CT.

The National Institutes of Health has committed $96 million to fund big data research centers, aimed at improving the ability of the research community to use and make sense of large and complex datasets.

Over a four-year span, $24 million annually will be set aside to establish six to eight Big Data Knowledge Centers of Excellence. The money will be used for the "development and distribution of innovative approaches, methods, software, and tools for data sharing, integration, analysis and management," according to NIH.

Despite the promise of remote patient monitoring to cut healthcare costs and improve patient care, the research methods behind those claims are called into question in a study published in the Journal of Medical Internet Research this week.

The researchers looked at systematic reviews and meta-analyses of home telemonitoring of patients with chronic conditions between 1966 and 2012. They focused on 24 reviews, nine of which were meta-analyses. Most such studies over the years deal with remote monitoring for patients with chronic heart failure, but in recent years, monitoring has grown more prevalent for other conditions, as well, such as diabetes, hypertension and asthma.

Clinical mobility spending in the United States is expected to grow from $2.9 billion in 2011 to $5.4 billion in 2016, a compound annual growth rate of 12.7 percent, according to a new IDC Health Insights report.

Growth in clinical mobility spending in the United States, while strong, is tempered by other demands on IT and the need to respond to health reform initiatives. However, the deployment of the meaningful use technologies, such as EHRs, eRx, CPOE and HIE, will accelerate the use of mobile point-of-care solutions to create more efficient clinical workflows, officials say.

A new mobile health trends report released Wednesday underscores the mid- to low sophistication of current mHealth application technology but also emphasizes the explosive growth and integration headed for the market .

The Research and Markets mHealth trends report shows the industry poised for a compound annual growth rate of 61 percent by 2017, to reach a value of $26 billion. This revenue, researchers project, will be derived predominantly from mHealth hardware sales and services.

Study findings also estimate that some 50 percent of mobile users will have downloaded mHealth applications within five years.

By the end of 2017, the mHealth industry is expected to have grown by a compound annual growth rate of 61 percent, to reach a value of $26 billion, according to a new report from Research and Markets.

The market for mHealth applications is developing along three different phases. Currently, mHealth players have entered the commercialization phase of the market. This phase can be characterized by a massive increase of offered solutions, the creation of new business models, and the concentration on private, health-interested people, patients, and corporations as major target groups.

The general sophistication of today's mHealth applications is low to medium, and many of the mHealth-categorized applications provide a limited benefit for patients, doctors, and health interested smartphone users. Nevertheless, advanced solutions do exist.

2013 has been billed as the year of EHR dissatisfaction, with up to 23 percent of physician practices reporting they were trading in their current EHR system for a new brand altogether, and, according to a new Black Book Rankings report, there were only a handful of vendors that came out on top.

The survey finds that providers switching to new EHR systems were turning to Practice Fusion, Care360 Quest, Vitera, Cerner, Greenway, ChartLogic, GE Healthcare and athenahealth — all vendors who have risen to the top of the replacement market satisfaction polls, officials note.

"Regularly, at least two of these eight vendors were on the short lists of 88 percent of the current replacement market buyers surveyed," said Doug Brown, managing Partner of Black Book, in a news release.

Seven others — Allscripts, AmazingCharts, eClinicalWorks, Kareo, McKesson and NextGen — also received top rankings in six of seven 2013 Black Book client experience surveys, Black Book officials noted.

Some U.S. states are reviewing their policies around the collection and sale of health information to ensure that some patients can't be identified in publicly available databases of hospital records.

Washington suspended distribution of the information and developed a confidentiality agreement that all buyers must now sign, according to Donn Moyer, a spokesman for the state’s Department of Health. Bloomberg News, working with Harvard University professor Latanya Sweeney, reported on June 4 that some patients of Washington hospitals could be identified by name and have their conditions and procedures exposed when a database sold by the state for $50 is combined with news articles and other public information.

Washington, Tennessee, Nevada and Arizona have begun privacy audits as a result of the report, according to inquiries made with health agencies by Bloomberg. California, Illinois, New Jersey, Massachusetts, Connecticut, Nebraska and Alaska already have reviews of their health data collection policies under way, they said.

In part one of this series we provided a loose definition of Big Data, described some of the ways that Big Data tools can be used in health, and identified the high degree of alignment of Big Data capabilities with quality and efficiency analytics as well as observational health research. Big Data tools also show great promise in managing the copious amounts of health data emanating from patients via social networking and home monitoring, as well as many areas that have a genomic data component. We also pointed out the irony that while quality and efficiency uses can frequently fall under HIPAA “treatment, payment, and operations,” patient identifiable data for research by virtue of being “designed to develop or contribute to generalizable knowledge,” must address much more strenuous constraints.

Some Big Data analytics and observational research can also be done on HIPAA de-identified data. But the traditional issues with de-identified data will be particular obstacles for other Big Data outcomes. Big Data tools and data sets, for example, will increasingly bring re-identification of HIPAA de-identified data to the fore.

When larger and broader publicly available data sets are joined with newly de-identified data, existing de-identification approaches become even less durable and identities become easier to re-establish.

2013 has been billed as the year of EHR dissatisfaction, with up to 23 percent of physician practices reporting they were trading in their current EHR system for a new brand altogether, and, according to a new Black Book Rankings report, there were only a handful of vendors that came out on top.

The survey finds that providers switching to new EHR systems were turning to Practice Fusion, Care360 Quest, Vitera, Cerner, Greenway, ChartLogic, GE Healthcare and athenahealth — all vendors who have risen to the top of the replacement market satisfaction polls, officials note.

"Regularly, at least two of these eight vendors were on the short lists of 88 percent of the current replacement market buyers surveyed," said Doug Brown, managing Partner of Black Book, in a news release.

Most physicians find implementing the technology and changes in practice required by Affordable Care Act challenging, according to a new survey from Wolters Kluwer Health.

More than 300 practicing physicians in primary care, family medicine and internal medicine responded to the poll. They cited their three biggest business challenges as managing shifting reimbursement models with payers (91 percent), financial management (90 percent) and spending time with patients (88 percent).

As more patients share information online, practices can benefit from establishing a presence and providing patients with digital communication options.

Physicians who forgo social media in their practices run the risk of falling behind patients’ growing demands for digital communication and allowing negative reviews to define their reputations, says a new research paper by HP Social Media Solutions, a digital consulting firm.

The report, released June 27, details why hospitals, health systems and physicians should have social media presences as more patients use technology to discuss and manage their health care. It says doctors who don’t use social media are more likely to be unaware of negative reviews posted by dissatisfied patients. Having no social presence online makes it difficult for doctors to respond to such reviews.

Scott Mace, for HealthLeaders Media , July 23, 2013

The countdown is on and the make-or-break technology backbone of the government's health insurance exchange is shrouded in questions about security and privacy. One health insurance vendor calls the scenario "a nightmare."

Don't let me give you the impression that technology doesn't have its down side.

It's too complicated. It takes too long to implement. Too often, training is an afterthought. The workforce usually isn't ready for sudden changes. Make the technology too constricting, and clever users will find a way around it, or they'll simply ignore it and go about their business in spite of carefully thought out laws and guidelines.

Recently, I talked with Morgan Hege, who runs an online insurance agency known as HealthInsurancePlus. I asked him how his business is going given the opening up of the health insurance exchanges this fall. He didn't mince words.

Before handing the job over, former national coordinator for health IT David Blumenthal, MD, crafted the Federal Health IT Strategic Plan 2011-2015 — a framework that incoming ONC chief Farzad Mostashari said at the time was “a gift” to the office.

ONC posted a progress report on July 19, assessing its achievements across the plan’s five goals. “Federal investments in a wide array of programs and activities, including the Meaningful Use EHR Incentive Program, have impacted the health IT marketplace, allowing the health care system to improve health and health care,” ONC said in the progress report.

If there’s one thing everyone in healthcare can probably agree on right now, it’s that there is an awful lot of data being generated each and every day. What to do with that data, however, is another question.

As Ted Driscoll, digital health director at venture capital firm Claremont Creek Ventures, sees it, the explosion of data is a definite boon for personalized medicine. Indeed, he said recently, “Medicine is becoming synonymous with big data – the data sets are just huge, now – but we had to wait for the IT revolution to happen and mature” in order to begin to put that data to use.

The long and winding road to federal regulation or oversight of mHealth still has some ground to cover, but a key Food and Drug Administration Safety Innovation Act sub-workgroup has tentative suggestions that are about three organizational layers removed from the FDA.

After a July 19 meeting, the FDSIA subgroup on regulations is sending a batch of tentative recommendations to the FDSIA Workgroup for consideration on the last Friday of July — before those and other ideas go to the ONC’s HIT Policy Committee and then the FDA.

The issues being considered by the regulation subgroup — chaired by Epstein Becker Green attorney Bradley Thompson and Partners HealthCare System’s biomedical engineering director Julian Goldman, MD — have been so complex and potentially impactful to the blossoming mHealth industry, that the exact language of recommendations are still being finalized amid subgroup member debate.

For the first half of 2013, health information technology saw more action in mergers and acquisitions than segments like healthcare business services, consumer health and pharma IT, according to a new report from New York-based investment bank Berkery Noyes.

Remaining the "most active" segment of the Healthcare/Pharma Information and Technology industry, health IT accounted for 63 transactions, 40 percent of the industry's aggregate volume in the first half of 2013.

System design: Create systems that interact easily--it is the "foundation of useability," he writes. A solid system design in an electronic health record can help to minimize and prevent medical errors while improving the quality of care delivered to patients, for example.

Giving patients the opportunity to access and view their electronic health records both improves patient experience and encourages stronger patient engagement in care management, according to a study in the Journal of Medical Internet Research.

Researchers convened five focus groups of the 30 patients participating in the My HealtheVet Pilot at the Portland (Ore.) Veterans Administration Medical Center.

Pinterest, the social bookmarking site where users collect and share photos, is now the third most popular social network behind Facebook and Twitter, according to Experian Marketing Services' latest Digital Marketer Benchmark and Trend Report.

As Pinterest grows in popularity, health care organizations looking to connect with their community online are taking notice.

"For me, the tipping point with Pinterest was when I noticed that people were actually pinning images from our site," said Amanda Davis, director of marketing and communications for the Ovarian Cancer National Alliance in Washington, D.C. "So I said I can see that our community is actually using this and they are finding visuals that they want to share, so I think it's time for us to join and make sure we're a part of that conversation too." Davis' organization has been on Pinterest for about a year now.

Greg Freeman , July 22, 2013

Hoping for a deadline extension, many physician practices are behind. Instead they should be highly focused on the transition from ICD-9 to ICD-10 code sets, says one expert.

With so many challenges and changes coming at physician practices, it can be hard to know where to focus attention. Healthcare reform is reshaping the way healthcare is provided and paid for it, and one of the most fundamental changes involves coding.

Physician practices should be highly focused on the transition from ICD-9 to ICD-10 code sets, says Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB, director of audit services with the AAPC in Salt Lake City. Stilley also is part of the AAPC's ICD-10 Curriculum Training Team, which assists physician practices in switching from the current set of 14,000 codes to over 69,000 codes.